When employees lack access to mental health treatments, employers bear the cost in terms of increased absenteeism and presenteeism. New research indicates there's much room for improvement when it comes to accessing mental health care.

 

The National Alliance on Mental Illness recently released a new report with scorecards for the states' mental health care systems, based on 65 specific criteria, such as access to medicine, housing, family education and support for National Guard members.

The national average grade was a D, reflecting a lack of adequate coverage for mental illness and substance abuse treatments in private and public health plans.

"Without coverage, people with serious mental illnesses can be financially devastated by the cost of the care," the NAMI report states.

"People who remain untreated — or undertreated — live with worsening conditions and eventually overwhelm our country's emergency departments, hospital wards and public systems."

NAMI's grades for 2009 include six Bs, 18 Cs, 21 Ds and six Fs. On a positive note, 14 states improved their grades since NAMI's last report card three years ago.

However, 12 states got worse grades this year. The ratings weighed many metrics, including emergency room wait-times, number of psychiatric beds per hospital, number of programs delivering evidence-based practices and the extent of shortages in the mental health workforce.

Oklahoma showed the greatest improvement in the nation, rising from a D to a B. South Carolina fell the farthest, from a B to a D. To see your state's grade, go to www.nami.org/grades09.

The report comes at a time when budget cuts are jeopardizing mental health care in some states. "Mental health care in America is in crisis," says NAMI Executive Director Michael J. Fitzpatrick. "Even states that have worked hard to build life-saving, recovery-oriented systems of care stand to see their progress wiped out.

"Ironically, state budget cuts occur during a time of economic crisis when mental heath services are needed even more urgently than before," he adds.

"It is a vicious cycle that can lead to ruin. States need to move forward, not retreat."

David Ballard, assistant executive director for corporate relations and business strategy at the American Psychological Association, says, "While there is no denying that the current economic downturn may necessitate some belt-tightening, employers should be careful not to secure this quarter's financial returns at the expense of employee well-being or the organization's long-term success."

Unfortunately, access to care is a problem. About two-thirds of U.S. primary care physicians report that they couldn't get outpatient mental health services for their patients — a rate that was at least twice as high as for other services, according to a national study funded by the Commonwealth Fund and recently published in the journal Health Affairs.

NAMI recommends improving data collection, outcomes measurement and accountability in the mental health system; standardizing data collection within and across the states; integrating mental and physical health programs; and expanding pilot programs that link physical and mental health. It also recommends covering preventive care in health plans and increasing the use of health and wellness programs.

State mental health agencies were the main source of information for NAMI's report. Other data were drawn from academic researchers, health care associations and federal agencies.

Federal policy

In October 2008, former President George W. Bush signed the Mental Health Parity and Addiction Equity Act, which requires health insurers to cover mental illness on par with physical illness in terms of the financial and treatment requirements. They cannot require higher copays, higher deductibles or stricter limitations on treatment for mental illness. Annual or lifetime dollar limits on mental health benefits cannot be lower than the dollar limits for medical and surgical benefits.

"Most states have some form of parity law governing private insurance plans, yet few of these laws result in coverage that is truly equitable or comprehensive," the NAMI report states.

With the new federal law, Karen Fuqua, president of the Fuqua Consulting Group in Ocean Springs, Miss., predicts, "We will see in the next three to five years a significant change in the benefit makeup because it will be law. The playing field will be leveled ... I believe we're going to see a better covered workforce and a more productive workforce."

Employees will be more likely to seek treatment for mental illness because the treatment will be covered; consequently, employers will see fewer problems associated with untreated mental illness, she adds.

AstraZeneca, a drug manufacturer with about 11,000 U.S. employees, used to have a carved-out mental health benefit with a separate copay and deductible for mental health services.

Several years ago, it started a process of integrating the mental health benefit into the health plan and disease management programs. As of January 2009, it moved to 100% mental health and substance abuse parity.

Kathy Brooke, director of North American benefits at AstraZeneca, predicts mental health parity will help the company to reduce absenteeism, promote productivity and improve retention rates.

"We recognized the need to treat the person as a whole" because mental illness often is comorbid with chronic conditions like diabetes, she comments.

"Access to care is so important to us. If we're investing in our employees' health, we want it to be the whole person."

To abide by the federal parity law, Fuqua advises HR pros to start the process of making plan design changes now, instead of waiting until the compliance deadline in January 2010.

She also recommends educating employees about the mental health coverage that's available to them and training supervisors on how to identify and respond appropriately to warning signs of mental illness. Mental health coverage can go a long way toward promoting employee loyalty, Fuqua notes.

One in four Americans experience mental illness at some point in their lives. The most serious conditions affect 10.6 million Americans, NAMI reports.

"Too many people living with mental illness end up hospitalized, on the street, in jail or dead," Fitzpatrick says.

"We need governors and legislators willing to make investments in change."

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Kudos to the 2009 Psychologically Healthy Workplace Award winners

The American Psychological Association recently recognized five employers with this year's Psychologically Healthy Workplace Awards:

• W R Systems, Ltd.- engineering services division
• Replacements, Ltd.
• Teledyne Brown Engineering — Huntsville headquarters
• WorldatWork
• Sandia Preparatory School

Efforts to promote employee health and well-being have resulted in less turnover, less absenteeism and additional cost-savings for the award-winners. The five organizations reported an average turnover rate of 11% in 2008, significantly less than the national average of 39% as estimated by the Bureau of Labor Statistics.

Further, only 25% of employees at the winning organizations reported experiencing chronic work stress, compared to 39% nationally, and 85% of employees at the winning organizations reported being satisfied with their jobs, compared to 61% nationally.

To choose the winners, APA evaluates nominees based on their programs and policies in the areas of employee involvement, health and safety, employee growth and development, work-life balance and employee recognition.